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Whole Blood Adsorber During CPB and Need for Vasoactive Treatment After Valve Surgery in Acute Endocarditis: A Randomized Controlled Study

  • Anna Holmén
    Affiliations
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Anna Corderfeldt
    Affiliations
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
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  • Lukas Lannemyr
    Affiliations
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden

    Department of Anesthesia and Intensive Care, Institution of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • Göran Dellgren
    Affiliations
    The Transplant Institute, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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  • Emma C Hansson
    Correspondence
    Address correspondence to Emma C. Hansson, Department of Cardiothoracic surgery, Blå stråket 5, plan 5, 413 45 Göteborg, Sweden.
    Affiliations
    Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden

    Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Published:February 26, 2022DOI:https://doi.org/10.1053/j.jvca.2022.02.028

      Objectives

      Patients with endocarditis requiring urgent valvular surgery with cardiopulmonary bypass are at a high risk of developing systemic inflammatory response syndrome and septic shock, necessitating intensive use of vasopressors after surgery. The use of a cytokine hemoadsorber (CytoSorb, CytoSorbents Europe GmbH, Germany) during cardiac surgery has been suggested to reduce the risk of inflammatory activation. The study authors hypothesized that adding a cytokine adsorber would reduce cytokine burden, which would translate into improved hemodynamic stability.

      Design

      A randomized, controlled, nonblinded clinical trial.

      Setting

      At a university hospital, tertiary referral center.

      Participants

      Nineteen patients with endocarditis undergoing valve surgery.

      Intervention

      A cytokine hemoadsorber integrated into the cardiopulmonary bypass circuit.

      Measurements and Main Results

      The accumulated norepinephrine dose in the intervention group was half or less at all postoperative time points compared to the control group, although it did not reach statistical significance; at 24 and 48 hours (median 36 [25-75 percentiles; 12-57] μg v 114 [25-559] μg, p = 0.11 and 36 [12-99] μg v 261 [25-689] μg, p = 0.09). There was no significant difference in chest tube output, but there was a significantly lower need for the transfusion of red blood cells (285 [0-657] mL v 1,940 [883-2,148] mL, p = 0.03).

      Conclusions

      There was no statistically significant difference between the groups with regard to vasopressor use after surgery for endocarditis with the use of a cytokine hemoadsorber during cardiopulmonary bypass. Additional, larger randomized controlled trials are needed to definitely assess the potential effect.

      Key Words

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      References

        • Belletti A
        • Jacobs S
        • Affronti G
        • et al.
        Incidence and predictors of postoperative need for high-dose inotropic support in patients undergoing cardiac surgery for infective endocarditis.
        J Cardiothorac Vasc Anesth. 2018; 32: 2528-2536
        • Rizza A
        • Bignami E
        • Belletti A
        • et al.
        Vasoactive drugs and hemodynamic monitoring in pediatric cardiac intensive care: An Italian survey.
        World J Pediatr Congenit Heart Surg. 2016; 7: 25-31
        • Cui WW
        • Ramsay JG.
        Pharmacologic approaches to weaning from cardiopulmonary bypass and extracorporeal membrane oxygenation.
        Best Pract Res Clin Anaesthesiol. 2015; 29: 257-270
        • Trager K
        • Skrabal C
        • Fischer G
        • et al.
        Hemoadsorption treatment of patients with acute infective endocarditis during surgery with cardiopulmonary bypass - a case series.
        Int J Artif Organs. 2017; 40: 240-249
        • Trager K
        • Fritzler D
        • Fischer G
        • et al.
        Treatment of post-cardiopulmonary bypass SIRS by hemoadsorption: A case series.
        Int J Artif Organs. 2016; 39: 141-146
        • Poli EC
        • Alberio L
        • Bauer-Doerries A
        • et al.
        Cytokine clearance with CytoSorb(R) during cardiac surgery: A pilot randomized controlled trial.
        Crit Care. 2019; 23: 108
        • Poli EC
        • Rimmele T
        • Schneider AG.
        Hemoadsorption with CytoSorb((R)).
        Intensive Care Med. 2019; 45: 236-239
        • Datzmann T
        • Trager K.
        Extracorporeal membrane oxygenation and cytokine adsorption.
        J Thorac Dis. 2018; 10: S653-Ss60
        • Elixhauser A
        • Steiner C
        • Harris DR
        • et al.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
        • Nielsen DV
        • Johnsen SP
        • Madsen M.
        Variation in use of peroperative inotropic support therapy in cardiac surgery: Time for reflection?.
        Acta Anaesthesiol Scand. 2011; 55: 352-358
        • Shahin J
        • DeVarennes B
        • Tse CW.
        The relationship between inotrope exposure, six-hour postoperative physiological variables, hospital mortality and renal dysfunction in patients undergoing cardiac surgery.
        Crit Care. 2011; 15: R162
        • Akil A
        • Ziegeler S
        • Reichelt J
        • et al.
        Combined Use of CytoSorb and ECMO in patients with severe pneumogenic sepsis.
        Thorac Cardiovasc Surg. 2021; 69: 246-251
        • Haidari Z
        • Wendt D
        • Thielmann M
        • et al.
        Intraoperative hemoadsorption in patients with native mitral valve infective endocarditis.
        Ann Thorac Surg. 2020; 110: 890-896
        • Diab M
        • Platzer S
        • Guenther A
        • et al.
        Assessing efficacy of CytoSorb haemoadsorber for prevention of organ dysfunction in cardiac surgery patients with infective endocarditis: REMOVE-protocol for randomised controlled trial.
        BMJ Open. 2020; 10e031912
        • Zuccari S
        • Damiani E
        • Domizi R
        • et al.
        Changes in cytokines, haemodynamics and microcirculation in patients with sepsis/septic shock undergoing continuous renal replacement therapy and blood purification with CytoSorb.
        Blood Purif. 2020; 49: 107-113
        • Saller T
        • Hagl C
        • Woitsch S
        • et al.
        Haemadsorption improves intraoperative haemodynamics and metabolic changes during aortic surgery with hypothermic circulatory arrest.
        Eur J Cardiothorac Surg. 2019; 56: 731-737
        • Ranucci M
        • Baryshnikova E
        • Ciotti E
        • et al.
        Hemodilution on cardiopulmonary bypass: Thromboelastography patterns and coagulation-related outcomes.
        J Cardiothorac Vasc Anesth. 2017; 31: 1588-1594